Clinical Review ABC of subfertility

Tubal subfertility

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7415.610 (Published 11 September 2003) Cite this as: BMJ 2003;327:610
  1. Yacoub Khalaf

    Introduction

    Patent fallopian tubes are a prerequisite for normal human fertility. However, patency alone is not enough—normal function is crucial. Although patients often view them as either open or “blocked,” the fallopian tubes are highly specialised organs. They have a critical role in picking up eggs and transporting eggs, sperm, and the embryo. The fallopian tubes are also needed for sperm capacitation and egg fertilisation. Because the egg is fertilised in the fallopian tubes and the first stages of development of the embryo occur during its four day journey to the uterine cavity, the tubes are also important in nutrition and development. The fallopian tubes are vulnerable to infection and surgical damage, which may impair function by affecting the delicate fimbriae or the highly specialised endosalpinx. A fallopian tube obstruction occurs in 12% to 33% of infertile couples,1 and so tubal patency should be investigated early.

    Causes of tubal damage

    Infection

    Pelvic infection is a major cause of tubal subfertility. Infective tubal damage can be caused by sexually transmitted diseases, or can occur after miscarriage, termination of pregnancy, puerperal sepsis, or insertion of an intrauterine contraceptive device. The severity of tubal subfertility after pelvic infection depends on the number and severity of episodes.2 Although a history of symptomatic pelvic inflammatory disease may heighten suspicion of tubal damage, most women with tubal infertility do not report it. Even in women with serological evidence of past chlamydial or gonococcal infections, most are unaware of the infection.

    Incidence of tubal occlusion after pelvic infection

    Chlamydia trachomatis

    Chlamydia trachomatis accounts for around half the cases of acute pelvic inflammatory disease in developed countries. It is the commonest sexually transmitted agent in the United Kingdom. Chlamydial infections are often not diagnosed because they are usually asymptomatic or have few signs of infection. Both symptomatic and asymptomatic chlamydial infections can damage the …

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